Effect of Frailty on Unplanned 30-Day Readmissions and Mortality in Cancer Patients.

Abstract

PURPOSE/OBJECTIVE(S)\nHospital readmissions are associated with poor patient outcomes including increased morbidity and mortality, as well as increased healthcare costs. The Hospital Frailty Risk Score (HFRS) represents a validated risk stratification tool used to predict readmission and death among non-cancer patients, however this tool has not been evaluated among cancer patients, which represent a unique cohort of patients. This study sought to evaluate the utility of the HFRS among cancer patients to predict the risk of 30-day readmission and death.\n\n\nMATERIALS/METHODS\nWe analyzed cancer patients within the National Readmission Database, a nationally representative longitudinal database, between January and November 2017. HFRS was calculated from ICD-10 diagnosis codes associated with the initial hospitalization. Study endpoints included readmission 30-days after the initial admission, length of readmission, hospital mortality, and hospital charges. A mixed effects multivariate logistic regression model was used to determine the association of HFRS on study outcomes while controlling for confounding variables.\n\n\nRESULTS\nWe identified 1,685,099 weighted cancer admissions, of which 924,095 (54.8%) were deemed frail (HFRS > 5). Most common causes of readmission included sepsis, acute kidney injury, respiratory failure, and neutropenia. On unadjusted analysis frailty was associated with a lower 30-day readmission rate (23.4% vs. 23.6%, P\u202f=\u202f0.04), but a significantly higher 30-day mortality rate (4.1% vs. 3.2%, P < 0.001). Among those readmitted, frail patients had longer hospital stays (7.0 days vs. 6.4 days, P < 0.001), and incurred higher charges across their hospitalizations ($20,644 vs. $18,321, P < 0.001). On multivariable analysis increased HFRS was associated with a decreased risk of readmission (odds ratio [OR]\u202f=\u202f0.91, P\u202f=\u202f0.04), and an increased risk of mortality (OR\u202f=\u202f1.50, P < 0.0001).\n\n\nCONCLUSION\nAn increased Hospital Frailty Risk Score was paradoxically associated with a decreased risk of readmission, though was associated with 30-day mortality among cancer patients. This research demonstrates that commonly used risk prediction scores may not generalize to cancer populations. More research is needed to develop and test risk-prediction algorithms specifically on cohorts of cancer patients to help personalize their supportive care.